Provider Demographics
NPI:1700347135
Name:WILLS, PAULINE MAGIC
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:MAGIC
Last Name:WILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0426
Mailing Address - Country:US
Mailing Address - Phone:517-887-8121
Mailing Address - Fax:517-887-8121
Practice Address - Street 1:913 W HOLMES RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-887-8121
Practice Address - Fax:517-887-8121
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)